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1.
Quantitative Ultrasound Assessment of Acute Bone Loss Following Spinal Cord Injury: A Longitudinal Pilot Study 总被引:14,自引:3,他引:11
S. J. Warden K. L. Bennell B. Matthews D. J. Brown J. M. McMeeken J. D. Wark J. D. Wark 《Osteoporosis international》2002,13(7):586-592
Spinal cord injury (SCI) results in substantial and rapid osteoporosis. Given its rapid onset, assessment of bone changes
in the early stages (first 6 months) following SCI is important. This is particularly pertinent if intervention is to be implemented.
Quantitative ultrasound (QUS) represents a potential assessment tool for the evaluation of skeletal changes in the early stages
following SCI. This longitudinal pilot study assessed changes in QUS measures of calcaneal broadband ultrasound attenuation
(BUA) and speed of sound (SOS) in 15 male subjects (age 23.9 ± 7.3 years) over a 6-week period. Their mean time since SCI
was 110.3 ± 34.5 days. Also assessed were bone mineral density of the calcaneus (BMDc) and proximal tibia (BMDt) using dual-energy
X-ray absorptiometry (DXA). Confirming the rapid onset of bone loss following SCI, BMDc and BMDt decreased by 7.5 ± 3.0% (p<0.001) and 5.3 ± 4.2% (p<0.001), respectively. QUS was sensitive to these changes. BUA decreased by 8.5 ± 6.9% (p<0.001), whilst SOS decreased by 1.5 ± 1.3% (p<0.001). Suggesting an influence of the material properties of bone on BUA, BUA was correlated with BMDc at both the initial
(r= 0.68, p<0.01) and final (r = 0.62, p<0.01) assessments. There were no significant correlations in the magnitude of change over the 6-week assessment period between
any of the skeletal measures (all p>0.05). This suggests that skeletal qualities other than material properties also influence QUS measures. Overall, this study
confirmed the rapid onset of bone loss following SCI and showed QUS to be a useful portable measure of acute bone changes.
This may allow assessment of bone loss and the efficacy of intervention on this loss in the early stages following injury,
a period where traditional axial DXA assessment is limited by practical constraints.
Received: 14 February 2001 / Accepted: 18 January 2002 相似文献
2.
Comparison of Six Calcaneal Quantitative Ultrasound Devices: Precision and Hip Fracture Discrimination 总被引:1,自引:0,他引:1
C. F. Njeh D. Hans J. Li B. Fan T. Fuerst Y. Q. He E. Tsuda-Futami Y. Lu C. Y. Wu H. K. Genant 《Osteoporosis international》2000,11(12):1051-1062
Quantitative ultrasound (QUS) is now accepted as a useful tool in the management of osteoporosis. There are a variety of
QUS devices clinically available with a number of differences among them, including their coupling methods, parameter calculation
algorithms and sites of measurement. This study evaluated the abilities of six calcaneal QUS devices to discriminate between
normal and hip-fractured subjects compared with the established method of dual-energy X-ray absorptiometry (DXA). The short-term
and mid-term precisions of these devices were also determined. Thirty-five women (mean age 74.5 ± 7.9 years) who had sustained
a hip fracture within the past 3 years, and 35 age-matched controls (75.8 ± 5.6 years) were recruited. Ultrasound measurements
were acquired using six ultrasound devices: three gel-coupled and three water-coupled devices. Bone mineral density was measured
at the hip using DXA. Discrimination of fracture patients versus controls was assessed using logistic regression analysis
(expressed as age- and BMI-adjusted odds ratios per standard deviation decrease with 95% confidence interval) and receiver
operating characteristics (ROC) curve analysis. Measurement precision was standardized to the biological range (sCV). The
sCV ranged from 3.14% to 5.5% for speed of sound (SOS) and from 2.45% to 6.01% for broadband ultrasound attenuation (BUA).
The standardized medium-term precision ranged from 4.33% to 8.43% for SOS and from 2.77% to 6.91% for BUA. The pairwise Pearson
correlation coefficients between different devices was highly significant (SOS, r= 0.79–0.93; BUA, r= 0.71–0.92). QUS variables correlated weakly, though significantly, with femoral BMD (SOS, r= 0.30–0.55; BUA, r= 0.35–0.61). The absolute BUA and SOS values varied among devices. The gel-coupled devices generally had a higher SOS than
water-coupled devices. Bone mineral density (BMD) and BUA were weakly correlated with weight (r= 0.48–0.57 for BMD and r= 0.18–0.54 for BUA), whereas SOS was independent of weight. All the QUS devices gave similar, statistically significant hip
fracture discrimination for both SOS and BUA measures. The odds ratios for SOS (2.1–2.8) and BUA (2.4–3.4) were comparable
to those for femoral BMD (2.6–3.5), as were the area under the curve (SOS, 0.65–0.71; BUA, 0.62–0.71; BMD, 0.65–0.74) from
ROC analysis. Within the limitation of the sample size all devices show similar diagnostic sensitivity.
Received: 2 February 2000 / Accepted: 1 May 2000 相似文献
3.
J. P. W. van den Bergh A. R. M. M. Hermus A. I. Spruyt C. G. J. Sweep F. H. M. Corstens A. G. H. Smals 《Osteoporosis international》2001,12(1):55-62
Klinefelter’s syndrome (KS) is a common sex chromosomal disorder associated with androgen deficiency and osteoporosis. Only
few bone mineral density (BMD) and no quantitative ultrasound (QUS) data are available in these patients after long-term testosterone
replacement therapy. We examined in a cross-sectional study 52 chromatin-positive KS patients aged 39.1 ± 12.4 years (mean
± SD). Patients had been treated with oral or parenteral androgens for 9.2 ± 8.2 years (range 1–32 years). Areal BMD and bone
mineral apparent density (BMAD, i.e., estimated volumetric BMD) at the lumbar spine, total hip and femoral neck were determined
by dual-energy X-ray absorptiometry. BMD T-scores in the patient group were calculated based on three different North American reference databases. The QUS parameters
broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus using an ultrasound imaging
device (UBIS 3000) and were compared with QUS results in a sex-, age- and height-matched control group. QUS T-scores were calculated based on the results of QUS measurements in 50 normal Dutch men between the ages of 20 and 30 years.
QUS and BMD results in the KS patient group were compared. Overall, based on the three reference databases, 46% and 63% of
the KS patients had a T-score between −1 and −2.5 and a further 10% and 14% had a T-score ≤−2.5 at the total hip and/or lumbar spine, as measured by areal BMD or BMAD, respectively. Thirty-nine percent of
the KS patients had a T-score between −2.5 and −1, while 2% had a T-score ≤−2.5 for BUA and/or SOS. BUA (77.7 ± 15.0 dB/MHz) and SOS (1518.8 ± 36.5 m/s) were significantly lower in the KS patients
than in age- and height-matched controls (87.1 ± 17.8 dB/MHz, p<0.005, and 1536.5 ± 42.5 m/s, p<0.05). Correlation coefficients between the QUS parameters and areal BMD (0.28 to 0.37) or BMAD (0.27 to 0.46) were modest.
ROC analysis showed that discrimination of a BMD or BMAD T-score ≤−2.5 with either BUA or SOS was not statistically significant.
Although a limitation of our study is that direct comparison of BMD and QUS T-scores is not possible because in the control group in which QUS parameters were determined no BMD measurements were performed,
we conclude that despite long-term testosterone replacement therapy, a considerable percentage of patients with KS had a BMD
T-score <−1 or even ≤−2.5, based on different North American reference databases. This percentage was even higher for BMAD.
QUS parameters were also low in the KS patient group when compared with Dutch control subjects. QUS parameters cannot be used
to predict BMD or BMAD in KS patients.
Received: 28 February 2000 / Accepted: 3 August 2000 相似文献
4.
E. W. Gregg A. M. Kriska L. M. Salamone R. L. Wolf M. M. Roberts R. E. Ferrell S. J. Anderson L. H. Kuller J. A. Cauley 《Osteoporosis international》1999,10(5):416-424
Quantitative ultrasound (QUS) assessment of bone is a strong predictor of hip fractures and is currently an FDA-approved
tool to identify women at risk of osteoporosis. However, few studies have investigated the lifestyle and genetic correlates
of QUS in women. This study investigated the cross-sectional associates of several lifestyle, demographic and genetic factors
with calcaneal QUS parameters (broadband ultrasound attenuation (BUA) and speed of sound (SOS)) in 393 women aged 45–53 years.
Leisure-time and historical physical activity, dietary calcium and protein, body composition, vitamin D receptor genotypes,
menopause status, other health behaviors, calcaneal QUS parameters and bone mineral density (BMD) were assessed at a single
clinic visit. Lean mass, recent physical activity and African-American race were the strongest correlates of SOS whereas dietary
protein, calcium and recent physical activity were the strongest correlates of BUA. These predictors explained 13% and 6%
of the variance in SOS and BUA, respectively. Smoking, alcohol intake, education, hormone replacement therapy, calcium and
vitamin D supplements, historical physical activity and vitamin D receptor genotypes were not significantly associated with
BUA or SOS. Lean body mass and premenopausal status were the strongest correlates of lumbar BMD whereas lean body mass, physical
activity, African-American race and body mass index were significantly related to femoral neck BMD. Physical activity remained
predictive of SOS after controlling for lumbar BMD. The spectrum and magnitude of risk factors for SOS and BUA, including
lean body mass, physical activity, race, protein and calcium intake, parallel previously observed predictors of BMD.
Received: 25 November 1998 / Accepted: 1 April 1999 相似文献
5.
Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and
assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal
women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared
with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound
index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5.
The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal
women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4
BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture
was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for
L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters
and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve
for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91.
Received: 7 January 1999 / Accepted: 18 May 1999 相似文献
6.
Quantitative Ultrasound of the Calcaneus and Falls Risk in the Institutionalized Elderly: Sex Differences and Relationship to Vitamin D Status 总被引:2,自引:0,他引:2
J. Zochling Y. Y. Sitoh T. C. Lau I. D. Cameron R. G. Cumming S. R. Lord J. Schwarz A. Trube L. M. March P. N. Sambrook 《Osteoporosis international》2002,13(11):882-887
Very frail older people constitute an increasing proportion of aging populations and are likely to contribute substantially
to costs due to osteoporosis. Quantitative ultrasound (QUS) of the calcaneus is potentially a simple method for assessing
fracture risk in frail elderly, but there have been few studies of male/female differences in QUS or its relationship to falls
risk or vitamin D status, which is often subnormal in this population. We studied QUS, falls risk and serum 25(OH)-vitamin
D in subjects living in institutional aged care facilities (hostels or nursing homes). The study sample comprised 294 men
(mean age 81.2 years, range 65–102 years) and 899 women (mean age 86.7 years, range 65–104 years). Broadband ultrasound attenuation
(BUA) and velocity of sound (VOS) were higher in men than women by approximately 30% and 2% respectively (p<0.0001) and this difference was maintained at all ages. Serum 25(OH)D levels were higher in men than women (p<0.001) but vitamin D deficiency was very common in both sexes and serum 25(OH)D was not associated with QUS in either sex.
There was no significant decline in BUA or VOS with age in men; however, for women BUA declined by 2.8–4.7% per decade and
VOS by 1% per decade (both p<0.001). Mean BUA T-scores were −1.55 and −2.48 at age 90 years in men and women. Quadriceps strength and weight but not serum 25(OH)D were significantly
associated with BUA. These data suggest only minor loss occurs at the calcaneal site in BUA and VOS with very old age in either
sex.
Received: 7 March 2002 / Accepted: 5 June 2002
Correspondence and offprint requests to: Professor Philip Sambrook, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Tel: +61 2 9926 7281. Fax: +61 2
9906 1859. e-mail: sambrook@med.usyd.edu.au 相似文献
7.
B. Cortet C. Cortet F. Blanckaert M. d’Herbomez X. Marchandise J.-L. Wémeau M. Decoulx D. Dewailly 《Osteoporosis international》2001,12(2):117-123
Quantitative ultrasound (QUS) of bone is a valuable tool in the assessment of postmenopausal osteoporosis. QUS and new markers
of bone turnover have been poorly assessed in Cushing’s syndrome, however. Twenty-five patients with Cushing’s syndrome (20
women, 3 men; mean age ± SEM: 38 ± 2 years) were studied and compared with 35 age- and sex-matched control patients (mean
age ± SEM: 38 ± 2 years). The following variables were measured in both groups: QUS parameters at the heel (BUA; SOS; Stiffness
Index, SI); bone mineral density (BMD) at both the lumbar spine (LS) and femoral neck (FN) by dual-energy X-ray absorptiometry;
and serum markers of bone turnover (osteocalcin, procollagen type I N- and C-terminal propeptides (PINP and PICP), bone alkaline
phosphatase (BAP), procollagen type I C-terminal telopeptide (ICTP) and urinary type I collagen C-telopepetide breakdown products
(CTX)). Both BUA and SI were decreased in patients with Cushing’s syndrome (p<0.01) but not SOS (p=0.08). BMD was also strongly decreased in Cushing’s syndrome, at both the LS and FN (p<0.005). The two markers of bone turnover statistically significantly different between the two groups were osteocalcin (mean
± SEM: 3.5 ± 0.7 ng/ml (Cushing’s syndrome) vs 6.4 ± 0.5 ng/ml (controls, p<0.01)) and CTX (mean ± SEM: 148.7 ± 17.1 μg/mmol Cr (Cushing’s syndrome) vs 220.8 ± 22.9 μg/mmol Cr (controls), p<0.05). The areas under the receiver operating characteristic curve (AUC) were 0.72 (BUA), 0.73 (SI), 0.90 (BMDLS), 0.81 (BMDFN), 0.83 (osteocalcin) and 0.64 (CTX) respectively. AUC was significantly higher for BMDLS than for both BUA and SI (p<0.05). Conversely AUC was not statistically significantly different for BMDFN as compared with either BUA or SI. AUC was also higher for osteocalcin than for other markers of bone turnover. In conclusion,
QUS of bone seems to be a relevant tool for assessing bone involvement in Cushing’s syndrome. QUS does have a lower sensitivity
compared with DXA, however, and the relevance of QUS cannot be ascertained until some longitudinal data are forthcoming. Except
for CTX, the other new markers of bone turnover assessed in this study (PINP, PICP, BAP and ICTP) do not seem of interest
in Cushing’s syndrome.
Received: February 2000 / Accepted: 24 August 2000 相似文献
8.
Quantitative Ultrasound Measurements of the Tibia and Calcaneus in Comparison with DXA Measurements at Various Skeletal Sites 总被引:2,自引:0,他引:2
The performance of quantitative ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly people
(age range 65–87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and
SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation
(CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral
density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual-energy X-ray absorptiometry
(DXA). Calcaneal QUS correlated better with BMD at various skeletal sites than tibial QUS. Calcaneal BUA showed higher correlations
with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r= 0.48–0.64, r= 0.30–0.47, r= 0.35–0.47, respectively; p<0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body
weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values.
After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests
that correction for body weight is important and could add to the predictive value of QUS measurements.
Received: 16 July 1997 / Accepted: 8 July 1998 相似文献
9.
J. P. W. van den Bergh C. Noordam A. Özyilmaz A. R. M. M. Hermus A. G. H. Smals B. J. Otten 《Osteoporosis international》2000,11(11):967-976
We investigated the quantitative ultrasound (QUS) parameters broadband ultrasound attenuation (BUA) and speed of sound (SOS)
measured in the posterior part of the calcaneus at the region of interest (ROI) with the lowest attenuation, using an ultrasound
imaging device (UBIS 3000) in 491 healthy Caucasian children and adolescents (262 girls, 229 boys) between 6 and 21 years
old. The relation of age, body weight, height, foot dimensions and pubertal stage to BUA and SOS was assessed. BUA increased
nonlinearly with age in boys and girls, r
2 being 0.44 (p<0.001) and 0.57 (p<0.001), respectively. SOS increased linearly with age in girls (r
2= 0.04, p<0.001). There was no significant increase in SOS in boys (r
2= 0.01, p>0.05). Heel width was significantly correlated with BUA (r= 0.20, p<0.005 in boys; r= 0.27, p<0.05 in girls) and with SOS (r=−0.19, p<0.005 in boys; r=−0.08, p<0.05 in girls). After downward adjustment of the ROI size according to foot length quartiles, significantly lower BUA and
SOS values were found compared with those with the standard ROI size of 14 mm. After correction for heel width and adjustment
of the ROI size based on foot length, BUA and SOS were significantly associated with age in boys (r
2= 0.36, p<0.001 and 0.06, p<0.05) and in girls (r
2= 0.53 and 0.06, both p<0.001). Tanner stage was significantly correlated with BUA (r= 0.62, p<0.001 in boys; r= 0.73, p<0.001 in girls) but not with SOS. BUA but not SOS increased significantly with the number of years since menarche (p<0.001). In a multiple stepwise regression analysis in boys, age, weight and foot length were independent predictors for BUA,
and age and foot length for SOS. In girls, age and weight were independent predictors for BUA and age was the only independent
predictor for SOS. After correction for age, pubertal stages and heel width were no longer determinants for QUS parameters
in either boys or girls. In conclusion, BUA increased significantly with age in both sexes. SOS increased with age in both
boys and girls, but the increase was small and not statistically significant in boys. SOS, as measured with the UBIS 3000
device, may therefore not be appropriate to assess skeletal status in healthy children. Whether SOS and BUA are affected in
children with skeletal disorders has yet to be determined. In boys, age, weight and foot length were independent predictors
for BUA and age and foot length for SOS. In girls, age and weight were independent predictors for BUA and age was the only
independent predictor for SOS. In our opinion, children with small feet should be measured with a smaller ROI diameter than
those with larger feet.
Received: 28 October 1999 / Accepted: 19 June 2000 相似文献
10.
S. Daens A. Peretz V. de Maertelaer M. Moris P. Bergmann 《Osteoporosis international》1999,10(4):278-283
Bone loss due to corticosteroid treatment differs from that of postmenopausal osteoporosis with regard to bone structure.
Corticosteroids affect both horizontal and vertical trabeculae while horizontal trabeculae are damaged in postmenopausal osteoporosis.
Dual-energy X-ray absorptiometry (DXA) is the gold standard to evaluate bone loss. The place of quantitative ultrasound (QUS),
a technique that could theoretically provide information on bone structure, is not well established in corticosteroid-induced
bone impairment. The aim of the study was to determine the usefulness of QUS in the assessment of corticosteroid-induced bone
impairment. We hypothesized that the relationship between QUS and DXA could be influenced by changes in bone structure and
thus differ with regard to corticosteroid treatment. Seventy-seven women with inflammatory diseases chronically treated with
corticosteroids (dose: 7.5–15 mg/day), 29 without corticosteroids and 100 controls were investigated. Bone mineral density
at the lumbar spine (BMDL) was measured by DXA and QUS parameters were measured at the calcaneus. Both the QUS parameters
(SOS, BUA, Stiffness) and BMDL were significantly lower (by 1.3% for SOS, 5.8% for BUA, 12.7% for Stiffness and 11% for BMDL)
in patients treated with corticosteroids compared with patients not taking corticosteroids and with controls (p<0.001, ANCOVA, with age and height as covariates). Multiple linear regressions of Stiffness, SOS and BUA as dependent variables
on age, BMDL, corticosteroid treatment and a computed new variable designed to test the interaction between BMDL and the treatment
group showed that Stiffness, SOS and BUA were dependent on age and BMDL (p<0.001); BUA and Stiffness were dependent on treatment group. Taking into account the age of the patients, a significant difference
was observed in the relation between BUA and BMDL according to treatment with corticosteroids. A similar difference was found
in the subgroup of patients without fractures. SOS and BUA were strongly correlated but their relation did not differ according
to treatment. Thus, QUS is useful in the assessment of corticosteroid-associated bone loss. Furthermore, the observation of
a significant difference in the relationship between BUA and BMDL with regard to corticosteroid treatment might support the
hypothesis that QUS, especially BUA, could give additional information about bone structure.
Received: 24 August 1998 / Accepted: 4 March 1999 相似文献
11.
The aim of this study was to evaluate the influence of immersion time and rotation of the heel around the leg axis on the
reproducibility of measurements using an ultrasound bone imaging scanner (UBIS) with a temperature-controlled water bath.
Measurements were obtained in 10 men, 11 premenopausal women and 10 postmenopausal women. The right foot of all subjects was
scanned 12 times with an interval of 3 min between each scan. The first 10 measurements, performed to study the effect of
immersion time, were taken without intermediate repositioning. Measurements 11 and 12 were also taken without removing the
foot, but the calcaneus position was varied by an angle of ±2.5° with respect to the reference position used during the first
10 measurements. Prolonged immersion of the heel led to a decrease in the variations of quantitative ultrasound (QUS) parameters
between successive measurements. Following rapid variations with immersion time, the QUS parameters reached a plateau. The
effect of immersion time on measurement error remained significant until the first two or three scans for broadband ultrasound
attenuation (BUA) and until the sixth or seventh scans for speed of sound (SOS). The variation in BUA was more pronounced
(p<0.05) for the group of postmenopausal women (20.7% change in BUA between the first and tenth scans; p<0.005) than for the group of premenopausal women (6.8% change in BUA between the first and tenth scans; p<0.005). The variations in SOS were similar in the two groups (0.8% variation; p<0.005). The impact of immersion time was smaller for men than for women [2.5%, (p<0.01) and 0.4% (p<0.005) of the change between the first and tenth scans for BUA and SOS respectively]. On the whole, the measurement errors
due to rotation of the heel were lower than those caused by immersion time. The variations were significant only in men and
premenopausal women. Both immersion time and rotation of the heel may play a role in the precision of QUS and should be carefully
standardized, particularly for longitudinal studies. In addition, following these results we have adopted a standardized protocol
to derive the technique reproducibility in groups of premenopausal and postmenopausal women. The coefficients of variation
were 1.1% for BUA and 0.1% for SOS in premenopausal women, and 1.4% for BUA and 0.13% for SOS in postmenopausal women.
Received: 17 February 1998 / Accepted: 1 September 1998 相似文献
12.
C. Heldan de Moura Castro M. Medeiros Pinheiro V. Lúcia Szejnfeld 《Osteoporosis international》2000,11(11):923-928
Quantitative ultrasound (QUS) can be a helpful alternative to identify osteoporotic patients. In this study we establish
the QUS Brazilian normal range (BNR) and compare its values (means and standard deviations) with the manufacturer’s normal
range (MNR). We measured three QUS parameters (broadband ultrasound attenuation, BUA; speed of sound, SOS; stiffness index,
SI) at the right calcaneus in 352 healthy Caucasian Brazilian women, aged 20–84 years. We studied the age-dependent changes
in QUS values and correlation with body size and years since menopause (YSM). A comparison of fracture risk classification
using the BNR and MNR is also presented. Age was the most significant predictor for all QUS parameters (r=−0.49 for BUA, r=−0.66 for SOS, r=−0.64 for SI). Weight was accepted as the second determinant for BUA (final regression model: BUA = 101.3 − 0.282 × Age +
0.373 × Weight; p<0.001; adjusted R
2= 0.33). Body mass index (BMI) was accepted as the second predictor for SI (SI = 94.8 −0.595 × Age + 0.851 × BMI; p<0.001; adjusted R
2= 0.44). Height and YSM were accepted as second and third determinants for SOS values (SOS = 1718.7 − 1.147 × Age − 69.863
× Height − 0.521 × YSM; p<0.001; adjusted R
2= 0.45).There was a decline in SI of about 41% from the values in young adulthood to those of women in their eighties, about
76.4% of which occurred from age 45–49 years onward. Variation of mean SI with age from the BNR was consistent with the MNR
in all but two 5-year age groups. In these two groups (50–54 years, p<0.01; 65–69 years, p<0.05), values derived from the BNR were 5.08% and 5.45% higher than the MNR values, respectively. Comparison of standard
deviations in SI with age between the two populations did not show statistically significant differences. Using the fracture
risk criteria proposed by the manufacturer, we observed that the MNR was appropriate for skeletal fragility evaluation in
Brazilian women.
Received: 8 November 1999 / Accepted: 26 April 2000 相似文献
13.
S. Gonnelli C. Cepollaro A. Montagnani S. Martini L. Gennari. M. Mangeri C. Gennari 《Osteoporosis international》2002,13(5):415-421
The possibility of using quantitative ultrasound (QUS) in monitoring the response to antiresorptive drugs has yet to be defined.
The aim of the present study was to evaluate whether heel ultrasonography, considering its characteristics of long-term precision,
is able to monitor osteoporotic patients treated with alendronate. We studied 150 postmenopausal osteoporotic women (age 59.6
± 5.3 years) treated with alendronate and calcium (n= 74) or with calcium alone (n= 76) for 4 years. At baseline and after 12, 24, 36 and 48 months, we measured bone mineral density (BMD) at the lumbar spine
by dual-energy X-ray absorptiometry (DXA, Hologic 4500), and speed of sound (SOS), broadband ultrasound attenuation (BUA)
and Stiffness at the calcaneus by Achilles plus. Moreover, the longitudinal precision of QUS parameters was assessed by measuring
10 subjects once a month for 1 year and, on the basis of the coefficients of variation we obtained, we calculated the Least
Significant Change between two measurements. In the alendronate-treated patients, at year 1, BMD increased by 4.2%, SOS by
0.4%, BUA by 1.1% and Stiffness by 3.2%; at year 2, BMD increased by 5.0%, SOS by 0.7%, BUA by 1.4% and Stiffness by 5.7%.
At year 3, BMD increased by 6.2%, SOS by 0.9%, BUA by 1.8% and Stiffness by 7.6%. At the end of the study period, BMD increased
by 7.6%, SOS by 1.2%, BUA by 1.9% and Stiffness by 9.0%. The minimal significant difference between two measurements was 0.8%
for SOS, 5.6% for BUA and 5.0% for Stiffness. Among the QUS parameters, Stiffness showed the greatest total treatment effect
and a longitudinal sensitivity which was only slightly lower than BMD. The MTI, which represents the period between scans
required to show that a ‘true’ change has occurred, was 1.8, 2.7, 11.9 and 2.2 years for BMD, SOS, BUA and Stiffness respectively.
Therefore, although the spinal BMD remains the optimal method, QUS at the heel, and in particular Stiffness, seems to be a
sensitive tool for monitoring the response to alendronate.
Received: 30 August 2001 / Accepted: 29 November 2001 相似文献
14.
Evaluation of a New Calcaneal Quantitative Ultrasound System and Determination of Normative Ultrasound Values in Southern Chinese Women 总被引:2,自引:0,他引:2
Quantitative ultrasound (QUS) assessment at the calcaneus has been found to be a safe and reliable method for evaluating
skeletal status. The present study aimed at evaluating the precision of the Sahara bone ultrasound densitometer and to determine
the normative QUS data in healthy southern Chinese women. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and
qualitative ultrasound index (QUI) were determined. The long-term in vitro precision of the Sahara machine over 6 months was
4.6% for BUA and 0.39% for SOS. The short-term in vivo precision was 3.2 ± 1.3% for BUA, 0.3 ± 0.2% for SOS and 1.8 ± 1.0%
for QUI. The standardized precision for BUA, SOS and QUI was 4.4, 3.8 and 2.2 respectively. The normative data were determined
in 1086 healthy subjects. Postmenopausal women had significantly lower BUA, SOS and QUI levels than the premenopausal women.
Significant negative correlations were observed between QUS indices and age. Bone mineral density (BMD) assessments was performed
on 349 of these subjects. BUA correlated significantly with lumbar spine BMD (r; = 0.326) and femoral neck BMD (r= 0.395). Similar correlations were observed between SOS, QUI and BMD, with r values ranging between 0.446 to 0.522. Despite the fact that Chinese women have significantly lower BMD values than Caucasian
women, the mean BUA values for pre- and postmenopausal Chinese women (73 ± 18 and 59 ± 18 dB/MHz respectively) were almost
the same as those reported for Caucasian womeo. These normative data will be useful in the assessment of southern Chinese
women with fracture risk.
Received: 7 May 1998 / Accepted: 18 August 1998 相似文献
15.
Quantitative Ultrasound of the Heel and Some Parameters of Bone Turnover in Patients with Acromegaly 总被引:2,自引:0,他引:2
Acromegaly caused by growth hormone (GH) hypersecretion is characterized by enhanced skeletal growth and soft tissue enlargement.
Insulin-like growth factor-1 (IGF-1) is the main peripheral mediator of GH action and it has a crucial role in the maintenance
of a normal bone mass. However, in some patients with acromegaly, secondary osteoporosis is observed, despite the strong anabolic
effect of GH and IGF-1 in bones. It is thought to be due to hypogonadism. The bone changes are accompanied by increased turnover.
The aim of this study was to assess bone properties by ultrasound and turnover in patients with acromegaly. The study was
carried out in 26 patients (13 men, 13 women): 14 with active acromegaly and 12 cured by surgery who had non-active disease.
Speed of sound (SOS), broadband ultrasound attenuation (BUA) and their combination Stiffness Index (SI) by quantitative ultrasound
(QUS) of the heel, hormonal status, serum osteocalcin (OC) concentration and the urinary excretion of pyridinoline collagen
crosslinks (PYR) were all studied. Controls were 20 age- and sex-matched healthy persons. We observed statistically significantly
lower QUS values in patients with active disease than in those whose disease was cured. The differences were more pronounced
in men. QUS values were lower in the entire group of patients compared with the controls; however, the differences were not
statistically significant. Serum OC concentrations and urinary PYR excretion were higher in active disease. Statistically
significant inverse correlations between serum GH levels and SOS (r=–0.58, p = 0.002); BUA (r=–0.66; p= 0.0001); T-score (r = −0,65, p= 0.0001) and Z-score (r=–0.66, p = 0.0001) were found only in male patients. No correlations between IGF-1, duration of the disease, OC, PYR and other data
studied were observed. In conclusion, we have shown decreased QUS parameters suggesting impaired bone properties and quality
in terms of density and elasticity in men, but not in women, with active acromegaly. This finding suggests osteoporosis with
increased bone turnover. The above-mentioned changes might be caused by the action of GH on trabecular bone and its metabolism,
since no hypogonadism in male patients was shown. Moreover, the influence of acromegaly on heel geometry and soft tissue swelling
should also be considered.
Received: 20 February 2001 / Accepted: 23 October 2001 相似文献
16.
Primary hyperparathyroidism (PHPT) may result in greater cortical than trabecular bone loss. Ultrasound is able to predict
osteoporotic fracture risk independent of densitometric measurements, but little is known about the changes in ultrasound
variables with PHPT. The aim of our study was to examine the effect of PHPT on ultrasound variables and bone density measurements
at cortical (hand) and trabecular (lumbar spine and heel) sites, and to evaluate their reversibility following surgical treatment.
We recruited 25 postmenopausal women diagnosed with PHPT ages 51–76 years (mean 62 years) and 95 postmenopausal controls ages
57–80 years (mean 67 years). Measurements were made at baseline and 1 year. Speed of sound (SOS) and broadband ultrasound
attenuation (BUA) of the heel were measured using the Lunar Achilles (LA+) and McCue CUBA Clinical (CC). Amplitude-dependent
speed of sound (AD-SoS) and ultrasound bone profile index (UBPI) of the fingers were measured using the IGEA DBM Sonic. Bone
mineral density (BMD) of the hand and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). At baseline,
hand BMD, LS BMD and heel BUA were significantly lower and finger UBPI significantly higher in the PHPT patients compared
with controls (p<0.001). There were no differences in Stiffness Index, heel SOS or finger AD-SoS between control and PHPT subjects. At 1 year
postoperatively, there was a mean (±SD) increase in LS and hand BMD of 3 ± 1% (p<0.01). BUA at the heel increased (11 ± 5%, p<0.001), and UBPI of the fingers decreased (17 ± 7%, p<0.001) probably reflecting different modes of attenuation in trabecular (scattering) and cortical (absorption) bone. Stiffness
Index, SOS of the heel and AD-SoS of the fingers did not change. BUA, UBPI and BMD returned towards normal postmenopausal
values following surgery. There were no changes in BMD or QUS variables at 1 year in the control group. Quantitative ultrasound
(QUS) measurements provide different information about bone structure than densitometric measurements and cannot be regarded
as simply reflecting bone density. With further research the combined use of BMD and QUS could improve the assessment of skeletal
status in patients with PHPT before and after surgery.
Received: 10 September 2001 / Accepted: 31 January 2002 相似文献
17.
M.-A. Krieg J. Cornuz A. F. Jacquet D. Thiébaud P. Burckhardt MD 《Osteoporosis international》1998,8(2):115-120
The assessment of bone quality by quantitative ultrasound (QUS), a transportable and relatively cheap method, shows some correlations
with bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) and with fracture risk. To examine its
correlation with bone metabolism in a population of institutionalized elderly people known to be at high risk for vitamin
D deficiency and secondary hyperparathyroidism, QUS of the calcaneus and biochemical parameters were measured in 264 women
aged 85±7 (SD) years and in 103 men aged 81±8 years living in 19 nursing homes. Vitamin D deficiency was frequent in this
population: 41.9% of the women and 31.4% of the men had a serum 25-hydroxyvitamin (25OHD) level below the 2.5th percentile
level of 3276 normal Swiss adults (6.2 μg/l or 15.5 mmol/l). Hyperparathyroidism was less frequent: serum parathyroid hormone
(PTH) levels were above the 97.5th percentile level of normal adults (70 pg/l) in 18.9% of women and 9.8% of men. In women,
QUS data correlated significantly with age (r=−0.297), body mass index (BMI) (r=0.403), calcium (r=0.220), PTH (r=−0.296), 25OHD (r=0.298) and alkaline phosphatase (AP) (r=−0.170) for broadband ultrasound attenuation (BUA), and with age (r=−0.195), BMI (r=0.208), PTH (r=−0.174), 25OHD (r=0.140) and AP (r=−0.130) for speed of sound (SOS). In men, ultrasound data correlated with BMI (r=0.326), calcium (r=0.199), 25OHD (r=0.258) and AP (r=−0.311) for BUA, and with AP (r=−0.196) for SOS. In women, but not in men because of their smaller number, a multivariate analysis was performed to examine
relationships between age, BMI, biochemical markers and QUS. Age, BMI, PTH and phosphate explained 30% of the variance of
BUA and 10% for SOS. In conclusion, QUS of bone evaluates characteristics of bone that are influenced, at least partially,
by age, BMI and the secondary hyperparathyroidism due to vitamin D deficiency.
Part of this work was presented at the 17th Annual Meeting of the American Society of Bone and Mineral Research in Baltimore,
MA, USA, September 1995. 相似文献
18.
The aim of this cross-sectional study was to assess the ability of quantitative ultrasound at the calcaneus to discriminate
between fractured and unfractured men, fracture probability, and the relationship of ultrasonic parameters to age and body
size. The study included 224 men (age range 36–86 years) with no history of diseases or therapy affecting bone metabolism.
The subjects were divided into two groups (unfractured, n= 148; fractured, n= 76) matched for age and body size. Bone status was assessed by ultrasound measurements at the calcaneus. Long-term in vitro
CV% values were 0.88% for speed of sound (SOS) and 0.54% for broadband ultrasound attenuation (BUA). In vivo CV% values were
0.33% for SOS and 2.48% for BUA, while sCV% values were 4.66% and 6.58%, respectively. The following SOS/BUA values were obtained:
in unfractured men, SOS = 1517.5 ± 35.3 m/s and BUA = 114.0 ± 13.3 dB/MHz; in fractured men, SOS = 1492.6 ± 24.6 m/s and BUA
= 106.1 ± 11.6 dB/MHz. The differences were significant (p<0.0001). The odds ratio for BUA for all fractures was 1.05 (95% CI, 0.03–2.07) and for SOS 2.13 (95% CI, 0.77–3.49). Only
the age-related decrease in SOS in unfractured men was significant (r=−0.17, p<0.05). In fractured men, weight and body mass index (BMI) were found to correlate significantly with BUA (r= 0.31, p = 0.007, r= 0.31, p = 0.007, respectively). The areas under receiver operating characteristics (ROC) curves were 0.706 for SOS and 0.665 for BUA.
Ultrasound measurements at the calcaneus thus enable discrimination between fractured and healthy males. Different patterns
of the relationship between age and body size in the two groups suggest the presence of other, unknown factors affecting bone
status. Their identification requires further prospective studies.
Received: 2 February 1998 / Accepted: 23 October 1998 相似文献
19.
Quantitative ultrasound (QUS) has been proposed as a tool which can measure both the quantitative and qualitative aspects
of bone tissue and can predict the future risk of osteoporotic fractures. However, the usefulness of QUS in long-term monitoring
has yet to be defined. We studied a group of early postmenopausal women over a 4-year period. Thirty subjects were allocated
to hormone replacement therapy and 30 selected as controls matched for age, years past the menopause (YPM) and bone mineral
density (BMD) at the anteroposterior spine (AP spine). The mean age of the subjects was 52.4 years (SD 3.9 years), mean YPM
4.0 years (SD 3.2) and all subjects had a BMD T-score above −2.5 SD (number of standard units related to the young normal mean population). BMD was measured at baseline
and annually by dual-energy X-ray absorptiometry (DXA) at the AP spine and total hip, and QUS carried out at the calcaneus,
measuring broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness. Mean percentage changes from baseline
were assessed at 2 and 4 years. The overall treatment effect (defined as the difference in percentage change between the two
groups) was: AP spine BMD, 11.4%; total hip BMD, 7.4%; BUA, 6.4%; SOS, 1.1%; and Stiffness, 10.4% (p<0.01). To compare the long-term precision of the two techniques we calculated the Standardized Precision, which for QUS was
approximately 2–3 times that of DXA, for a given rate of change. The ability of each site to monitor response to treatment
was assessed by calculating the Treatment Response Index (Treatment Effect/Standardized Precision), which was: AP spine BMD,
10.4; total hip BMD, 3.9; BUA, 3.1; SOS, 0.3; and Stiffness, 4.2. This was then normalized for AP spine BMD (to compare the
role of QUS against the current standard, AP Spine BMD), which was: total hip BMD, 0.38; BUA, 0.30; Stiffness, 0.40 (p<0.01); and SOS, 0.03 (NS). In summary, QUS parameters in the early menopause showed a similar rate of decline as AP spine
BMD and total hip BMD measured by DXA. Hormone replacement therapy results in bone gain at the AP spine and total hip, and
prevents loss in BUA and SOS measured by QUS at the calcaneus. QUS has a potential role in long-term monitoring, although
presently the time period to follow individual subjects remains 2–3 times that for DXA, for a given rate of change. Anteroposterior
spine remains the current optimal DXA monitoring site due to its greater rate of change and better long-term precision.
Received: 20 January 1999 / Accepted: 14 June 1999 相似文献
20.
In Vivo MRI Measurements of Bone Quality in the Calcaneus: A Comparison with DXA and Ultrasound 总被引:5,自引:0,他引:5
Magnetic resonance imaging (MRI) has shown promise in the assessment of bone architecture. The precision and feasibility
of MRI measurements in osteoporosis in vivo have been assessed in this study. T2′ was calculated from measurements of T2 and
T2* in the calcaneus of 32 postmenopausal women using a gradient-echo sequence PRIME (Partially Refocused Interleaved Multiple
Echo). This sequence allows the measurement of T2 and T2* in one acquisition. In vivo measurements of bone mineral density
(BMD) by dual-energy X-ray absorptiometry (DXA) were made in the calcaneus, spine and femoral neck. The ultrasound parameters
broadband ultrasound attenuation (BUA) and speed of sound (SOS) were also measured in the calcaneus. These three techniques
have not previously been compared in the same study population. The precision of the MRI technique was poor relative to the
DXA and ultrasound techniques, with a CV of 6.9%± 4.4% for T2′ and 5.5%± 3.6% for T2*. Approximately 4% of this is due to
system error as determined by phantom measurements. The postmenopausal women were classified as having low BMD if they had
a lumbar spine (L2–4) BMD of less than 0.96 g/cm2 (more than 2 standard deviations below normal peak bone mass). Calcaneal T2′ was significantly correlated with calcaneal
BMD (r = –0.79, p <0.0001), BUA (r = –0.59, p = 0.0004) and SOS (r = –0.58, p = 0.0006). T2′ was significantly different in postmenopausal women with normal BMD and those with low BMD (p <0.01). However, the difference was of only borderline significance (p <0.06) after adjustment for age and years since menopause.
Received: 8 July 1997 / Accepted: 29 April 1998 相似文献